Studies show that handwashing with soap can reduce the risk of contracting diarrhoea by up to 47%. In Fort Dauphin, a small town in the South East of Madagascar, poor hygiene practices and widespread open defecation has had serious consequences for a population struggling with diarrhoea and malnutrition. Poverty and poor infrastructure means that the overwhelming majority of residents do not have in-house water connections. Water must bought by the bucket, at public water points throughout the town. With water such a scarce resource, handwashing is not always seen as a primary concern. It is in this challenging environment that we must develop persuasive strategies to communicate the importance of handwashing with soap and the huge potential for the reduction in diarrhoea rates.
As part of our urban sanitation and hygiene project at SEED Madagascar we promote the use of handwashing stations, usually in the form of tippy taps, alongside newly constructed pit latrines. However, as many behavioural change studies show, this does not necessarily mean stations will continue to be used at critical times. Therefore, we must also look towards effective communication techniques which promote the sustained use of handwashing stations and disseminate key messages regarding handwashing with soap.
Using Frontiers Issue 2: How to Trigger for Handwashing with Soap as a guide, our Malagasy team trialled some of the practical tools developed by UNICEF Malawi and Salima District Council with the aim to increase handwashing with soap at critical times within our target population.
The structure of our project enabled these new tools to be incorporated into existing activities via focus groups held within the community. These groups are run by community liaison officers (CLOs) in conjunction with natural leaders who have emerged through the triggering process. Focus groups, held over a 3 month period, provide a platform for community engagement in sanitation and hygiene issues, allowing for knowledge sharing amongst residents and an opportunity for CLOs to provide advice on hygiene practices.
After identifying the most relevant tools within the guide, training was provided for the CLOs on the following activities:
- Anal cleansing materials
- Shit and shake
- Charcoal smearing
- Food Sharing
Once CLOs were fully trained and confident with the tools, focus groups were carried out across our target areas within Fort Dauphin. Comparable to other triggering events, the effectiveness of these tools depended on the facilitator’s ability to engage participants and build rapport with the community; therefore we found it was beneficial to use facilitators who were already experienced at triggering. CLOs identified that these tools were useful to facilitate more participatory and engaging discussions compared to just giving advice on good hand hygiene. The shocking nature of the tools provoked greater discussion allowing community members to take a more active role in focus groups. Furthermore, CLOs indicated that participants were often willing to give examples of poor hygiene practices they had witnessed or experienced.
Our monitoring activities showed that on average, 88% of households with newly built latrines who attended a ‘triggering for handwashing’ focus group had also built a handwashing station (with 70% also using soap or ash). This was a significant increase in handwashing stations compared to data collected on participants a year earlier who had only received handwashing advice without the use of practical tools; 66% of households had a handwashing station and only 40% were using soap or ash.
Although it is difficult to measure whether these handwashing stations are in constant use at critical times, we feel as a team that these practical tools have helped to trigger people to build handwashing stations and create more discussion on handwashing within community focus groups. Subsequently we feel that these tools can be very useful to incorporate into CLTS programmes to trigger handwashing with soap and will continue to use them as part of our behaviour change communication.
Bethany Lomas is the Urban Sanitation and Hygiene Specialist for SEED Madagascar.
